Skull Base Surgery Center

Our Center

Led by Raphael Davis, MD and David A. Schessel, MD, PhD, the Stony Brook University Skull Base Surgery Center offers state-of-the-art diagnosis and treatment for skull base tumors. Skull base tumors are tumors that form in the base of the skull where the head and neck meet and can be benign or malignant. The skull base area of the body contains many nerves, blood vessels, and glands, and damage can affect vision, hearing, speech, swallowing, and can even be life-threatening. In the past, surgery for conditions in this area was impossible because of the complexity and risks involved. However, advances in technology as well as surgical techniques now make it possible for a multidisciplinary surgical team to perform successful surgery. Our team combines experts in neurosurgery, otolaryngology (ear, nose, and throat), head and neck surgeons, radiology, and anesthesiology, all of whom have extensive experience in treating patients with skull base disorders.

The Stony Brook Difference

Led by Raphael Davis, MD and David A. Schessel, MD, PhD, the Stony Brook University Skull Base Surgery team is a group of specialists who have developed expertise in treating skull base disorders. Because of their complexity, no single surgeon can perform the demanding procedures involved in skull base disorders by him or herself, and Stony Brook University Medical Center's Skull Base Surgery team takes a collaborative approach in your treatment.

An academic institution that is built on the foundation of a well-respected university, the Stony Brook University Skull Base Surgery Center offers multidisciplinary care for complex skull base disorders. Our team offers highly skilled specialists, including neurosurgeons, neurotologists, otolaryngologists (ears, nose, and throat), head and neck surgeons, radiologists, neuroanesthesiologists, physician assistants, and nurse practitioners, that have trained and focus on diseases in the skull base. We are the only center in Suffolk county to offer this type of multidisciplinary approach.

The rare combination of neurosurgeons and otolaryngologists allows the specialists to approach hard-to-reach tumors in different ways and manage more extensive exposure during the surgery. This leads to higher quality outcomes and greater hearing preservation.

Just as no one surgeon can offer all of the surgical procedures required, no single procedure or treatment is right for every patient. We have the experience to know when a surgery will or will not benefit you, and after a thorough evaluation, we will recommend the most appropriate treatment plan. Our philosophy is to offer the most conservative treatment possible and to apply state-of-the-art procedures and technology when beneficial. Treatment plans are individualized to each patient's needs, and can include watchful waiting with close observation, medical therapies, chemotherapy, stereotactic radiation, image-guided surgery, minimally invasive and endoscopic techniques, or open surgery. The choice of treatment depends on:

The type, size, location, and the direction of growth of the tumor;

The patient's symptoms and their duration; and

The age and health of the patient.

We take the time to fully discuss your condition and your treatment options. More important, we take the time to listen to you and your preferences before we recommend the treatment option that is best for you. From your initial appointment through post-operative care and follow up, we use a streamlined, multidisciplinary approach to manage your condition, closely coordinating your care and monitoring your progress. We also coordinate any necessary aftercare including rehabilitation services for speech, swallowing, balance, or other related needs, if necessary.

The Stony Brook Skull Base Surgery team has particular expertise in the treatment of trigeminal neuralgia, which is a facial nerve disorder that occurs when a blood vessel comes in contact with a nerve (the sensory and motor nerve), causing painful pressure. The goal of surgical treatment of trigeminal neuralgia is to decompress, damage, or destroy the portion of the trigeminal nerve that is causing the pain. We offer percutaneous rhizotomy, a minimally invasive treatment in which the nerve is destroyed using radiofrequency energy; microvascular decompression, in which the neurosurgeon relocates or removes blood vessels compressing the nerve and then place a pad on the part of the nerve as protection from further compression; and stereotactic radiosurgery, a non-invasive treatment in which highly focused beams of radiation destroy the compressed portion of the trigeminal nerve while sparing surrounding tissue. Each treatment has benefits and drawbacks, and we will work with you to determine your best treatment option.

What Is It?

Stony Brook University Skull Base Surgery Center provides comprehensive treatment for a wide variety of skull-based disorders. The most common disorders include:

Pituitary tumors;

Meningiomas; and

Acoustic neuromas (vestibular schwannomas).

Skull base surgery encompasses a wide variety of operations performed where the brain and neck meet. There are a range of surgical techniques that can be used to perform skull base surgery, including open surgery, minimally invasive procedures, and stereotactic radiotherapy. In open surgery, incisions are made in the head (cranium) and face and a small amount of bone is removed to allow access to the surgical area. Various surgical approaches can be used to access tumors in different areas of the skull base region. Minimally invasive techniques, such as endoscopic surgery, allow us to gain access to the surgical area using a smaller incision, which results in reduced pain, infection and complication rates, and hospital stay. Stereotactic radiotherapy is a form of radiation therapy in which x-rays are delivered to a precisely focused area to treat tumors and vascular malformations.